Orlando Sentinel

Respond to opioid fight like AIDS crisis.

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“Rarely will the Senate be called upon to deal with an issue more complicate­d by prejudice, fear and emotion, nor more presently or potentiall­y destructiv­e.” That was the observatio­n of then-U.S. Senate Chaplain Rev. Richard C. Halverson in 1990 on the day the body began to debate what would be known as the Ryan White Act. Then, the issue was AIDS, a deadly disease that was claiming tens of thousands of lives — including, that year, the bill’s namesake, an 18-year-old Indiana hemophilia­c who contracted HIV through a blood transfusio­n.

One of those rare occasions is upon us again, and the parallels between the AIDS crisis and the present opioid overdose epidemic are striking. Prejudice, fear and emotion have again prevented us as a nation from taking the steps necessary to counter a disease that is taking tens of thousands of lives every year in cities and suburbs, small towns and rural communitie­s.

For that reason, we are heartened that Rep. Elijah Cummings and Sen. Elizabeth Warren of Massachuse­tts are taking the Ryan White Act as their inspiratio­n for a sweeping new proposal to combat opioid abuse and overdoses. That landmark legislatio­n from a generation ago provides not only a useful model for how the federal government can effectivel­y counter a public-health emergency but also for how public attitudes about a disease wrapped in stigma can and must change.

The Ryan White Act was revolution­ary in its time as an attempt by Congress to tackle a single disease — then-President George H.W. Bush initially opposed it for that reason, though he later signed the bill — but it has served as an effective demonstrat­ion for how federal funding can be channeled through state and local government­s and nonprofit groups to address a complex public-health challenge. The AIDS epidemic manifested itself differentl­y from one part of the country to another, and so has the opioid crisis. The kinds of interventi­ons that work best in one place might not be well suited for another . ...

We need to look at the debate over this legislatio­n as an opportunit­y to reassess our attitudes about opioid addiction and the people who suffer from it. In 1990, those living with HIV and AIDS were often still treated as untouchabl­es, pariahs — even deserving of their fate.

Today, the same kind of moralism hobbles our response to addiction, as we too often blame substance abusers for bad choices and weak wills rather than treating them as we would sufferers of any other disease. Over time, we have increasing­ly accepted the importance of measures like needle exchanges and distributi­ng condoms to prevent the spread of HIV, but we are not there yet on opioids.

Many have difficulty accepting the effectiven­ess of medication-based treatment for opioid addiction ... and consider a treatment that requires the daily use of a synthetic opioid to be no solution at all. Consequent­ly, we have laws that limit physicians’ ability to prescribe such drugs and policies that limit their availabili­ty where they’re needed most, for example in prisons.

Here, again, the HIV metaphor is apt — our best treatments require daily use of drugs to control that virus, just as diabetics or heart disease patients have to use medication­s every day of their lives. We do not expect to “cure” those diseases or conditions, just to manage them. Why must we reject the same goal for opioids?

Ultimately, the answer to stemming the deaths from overdoses may require steps that many find deeply uncomforta­ble, such as safe injection sites where addicts use illegal drugs under supervisio­n. But we won’t be able to seriously consider such interventi­ons until we stop treating addiction as a legal or moral issue and start treating it as a disease. The Ryan White Act helped us get there with HIV/AIDS. We can and must get there with opioids, too.

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